First Author: D.Maltsev RUSSIA
Co Author(s): A. Kulikov D. Kutik N. Arsenov
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For decades, fluorescein angiography (FA) has been the only technique which allows to clearly identify serous retinal detachment and the leakage point in central serous chorioretinopathy (CSC). Nowadays, the number of optical coherence tomography (OCT) findings allows to confirm CSC without FA in most of the cases. Nevertheless, identification of leakage point without FA is still considered not possible. The present work aims to evaluate OCT findings in CSC patients, allowing leakage point to be identified without FA and to estimate the proportion and characteristics of the CSC patients who may undergone FA-free focal laser photocoagulation (FLP) of leakage point.
This retrospective cohort study was conducted at Military Medical Academy, St. Petersburg, Russia
In this study, we retrospectively reviewed medical records of 48 eyes of 48 symptomatic CSC patients with presence of a leakage point confirmed with FA. In all patients, OCT imaging, retro-mode confocal scanning laser ophthalmoscopy (RM-SLO) and FA were performed. Three-dimensional macular scans were obtained using the RTVue-100 OCT (Optovue, Fremont, CA) with 3D-Reference scan pattern, RM-SLO and FA images were obtained with scanning laser ophthalmoscope F-10 (Nidek, Gamagori, Japan). The number of pigment retinal detachments (PED) and photoreceptor outer segments (PROS) length were evaluated on en face OCT images and B-scans respectively. For each leakage point the location in relation to both vertical dimension of the retinal detachment area and horizontal line centreed on the foveal centre was evaluated using ImageJ. The cumulative spatial distribution of leakage points within posterior eye pole was analyzed after superimposition of RM-SLO images from all 48 eyes with leakage point shown onto a single RM-SLO image. For analysis of the spatial overlap between leakage points and PEDs en face OCT images were superimposed on FA images. For comparing continuous parametric variables one-way ANOVA was used. All P values <0.05 were considered as statistically significant.
Coincidence of leakage point with PED was found in 44 (91.7%) eyes, of which 32 (72,7%) eyes had the single PED. In group of 12 eyes that had 2 or more PEDs, 60.6% of PEDs (20/33) coincided with a leakage point, and 75.0% of patients (8/12) had the single leakage point. Mean distance from upper border of retinal detachment area to leakage point was 27.3±13.0% of vertical dimension of the retinal detachment area. Fifty-one of 56 (91.1%) leakage points were localized no lower than the horizontal line centreed on the foveal centre. PROS length tended to be lower in the area above the PED which coincided with a leakage point (22.5±4.5 µm) compared to the area outside of the leakage point (64.0±9.4 µm) (p<0.001). PROS thinning was found in 50 of 56 (89.3%) of PEDs which coincided with leakage points (40 of 44 (90.1%) of eyes that had at least one PED). Finally, 26 of 48 (54.2%) patients met the criteria (non-resolved CSC associated with one or two PEDs at least one of which was found in upper ½ area of retinal detachment and was colocalized with leakage point and area of PROS thinning) for FA-free FLP.
In this study, the presence of both PED and PROS thinning coinciding with leakage point was found in a significant number of eyes with CSC. This study also showed that in the majority of eyes with CSC, the leakage point coincided with PED located in upper half of the retinal detachment area. Taken together, these findings allow to plan and perform FLP based on OCT imaging alone without FA in a significant proportion of CSC patients. In addition, the majority of leakage points was found to localize not lower than horizontal line centreed on the foveal centre. It appears that specific area of posterior pole may have a predisposition to choroidal hyperpermeability and RPE decompensation manifesting as CSC.